Page 1 of 22
Deer Valley Unified School District
Career and Technical Education – Nursing Services Introduction to Nursing Professions Syllabus/Handbook Date: Fall/Spring 2020 - 2021
Course Title: Introduction to Nursing Professions/Nursing Assistant (INP/NA) Possible High School Credit Hours: 2 (1 each semester)
Possible Classroom/Lab Hours: 250 Clinical Hours: 40
Instructors Responsibilities Phone Number E-Mail
Bobbie Kithcart, RN Clinical Instructor HOSA Advisor
(623) 633-3304 [email protected]
Angela Jensen, RN, BSN Classroom Instructor Program Coordinator HOSA Advisor
(602) 467-6865 [email protected]
Class Type Times Location
Classroom/Lecture
& Skill Lab:
Monday – Friday (2 hour blocks)
See student schedule
Deer Valley High School 18424 N 51st Ave, Glendale, 85308 Clinical 3 per semester
Fall Semester
Spring Semester
0645-1430* Clinical Agency The Palazzo 6250 N 19th Ave, Phoenix, 85015
Abrazo Arrowhead Hospital 18701 N 67th Ave,
Glendale, 85308 Instructional Materials:
Textbook: Sorrentino, Sheila A., and Leighann N. Remmert. Mosby's Textbook for Nursing Assistants. Ninth ed., Mosby, 2017. ISBN#: 978-0-323-31974-4
Workbook: Sorrentino, Sheila A., and Leighann N. Remmert. Mosby’s Workbook for Nursing Assistants. Ninth ed., Mosby, 2017. ISBN#: 978-0-323-31976-8
Learning Resources:
State Board of Nursing (AZBN) D & S Diversified Technologies LLP/Headmaster LLP 1740 W. Adams St. Suite 2000 Phone: (800) 393-8664
Phoenix, AZ 85007 www.hdmaster.com
Phone: (602) 771-7800
http://www.azbn.gov My Clinical Exchange
https://myclinicalexchange.com
Page 2 of 22
Course Description:
This course follows the curriculum designed & approved by the Arizona State Board of Nursing (AZBN), Arizona State Board of Education and Deer Valley Unified School District (DVUSD) Academic Planning Guide for certification of Nursing Assistants. It introduces the student to the role of the nursing assistant for clients across the wellness/illness continuum within the nurse assisting scope of practice. This course includes basic problem solving processes specific to meeting the basic and holistic needs of clients, therapeutic communication skills essential for the nursing assistant, interventions to ensure the needs and safety of the client, specific types of diseases, conditions and alterations in behavior of the client, and principles of nutrition and fluid balance. Focus is on special needs of the elder client in the acute and long-term care settings, and basic emergency care skills and procedures. It provides opportunity for the development of clinical competency in the performance of selected nurse assisting skills and procedures through participation in the care of clients.
Certification Information:
Students seeking certification/licensure from AZBN must obtain: successfully completion of INP/NA program, a minimum of proficient on all skills in skill lab, attend required 40 clinical hours with a passing clinical grade, meet attendance expectations of a minimum 250 hours combined in classroom/skill lab, pass with a 75% or higher on the comprehensive final exam. Upon satisfactory completion DVUSD INP/NA program provides a Certificate of Completion. Student is then eligible to take the written and skills AZBN certified nursing assistant (CNA)/licensed nursing assistant (LNA) exams to become a CNA/LNA, and can choose to go directly to the workforce and/or continue to pursue education opportunities in other healthcare careers. Information on the Arizona State Board of Nursing application process is available at http://www.azbn.gov. State certified evaluators administer the certifying exam and students may take the exam scheduled at local test centers including DVHS. In 2010, DVHS became a certified testing site for taking the CNA/LNA (licensed nursing assistant, requires fingerprinting) written and skills exams. If you have further questions regarding eligibility for licensure or certification, contact the Arizona State Board of Nursing at http://www.azbn.gov
Waiver of Licensure/Certification Guarantee:
Admission or graduation from the DVUSD INP/NA Program does not guarantee obtaining a license or certificate to practice nursing. Licensure and certification requirements and the subsequent procedures are the exclusive right and responsibility of the Arizona State Board of Nursing. Students must satisfy the requirements of the Nurse Practice Act: Statutes, Rules and Regulations, independently of any school requirements for graduation. According to A.R.S. § 32-1646 (B), an applicant for nursing assistant certification is not eligible for certification if the applicant has had any felony convictions and has not received an absolute discharge from the sentences for all felony convictions. The absolute discharge from the sentence for all felony convictions must be received three (3) or more years before submitting this application. If you cannot prove that the absolute discharge date is three or more years, the Board will notify you that you do not meet the requirements for certification.
The Arizona State Board of Nursing office is located at 4707 North 7th Street, Suite 200, Phoenix, Arizona, 85014-3653.
Phone: 602-771-7800, FAX: 602-771-7888. Website: https://www.azbn.gov.
Program Requirements:
All students must apply through their home school guidance department. Individual schools may have additional requirements. General requirements for admission into the DVUSD Introduction to Nursing (CNA) Program include:
⮚ Must be a high school senior
⮚ Application and acceptance into the program
⮚ A score of 75% or better on the English reading and math entrance exam
⮚ Completed Healthy and Safety Packet (Copies Due first week of school)
Proof of immunity, immunization or current testing for MMR, Varicella, Tdap, HepC
Current negative TB skin test dated July or later of current school year
Current annual Influenza vaccine**(required by clinical agencies)
Page 3 of 22
Current BLS HealthCare Provider CPR card valid through end of program
Completed Health Care Provider Signature form
Proof of Health Insurance
Background clearance document
Proof of United States Citizenship (required by AZBN)
* All documents must remain current throughout the program. Failure to provide the above documentation will result in dismissal from the program. PERSONAL EXEMPTION for any reason are not accepted.
Proof of current school year season’s influenza (flu shot)** is to be completed & submitted as soon as vaccines become available, usually August/September. Clinical instructor will establish the final due date (before clinical start date).
PERSONAL EXEMPTIONS FROM IMMUNIZATIONS WILL NOT BE ACCEPTED. DVUSD INP/NA Program cannot be held responsible for clinical agency immunization requirements that may prohibit a student from attending a clinical rotation.
Proof of current student Health Insurance must be provided. If a student is injured during the clinical experience the student should notify the clinical instructor and fill out both a DVUSD student incident form and a clinical site incident form.
Background Check - No felony convictions According to A.R.S. § 32-1606(B), an applicant for certified nursing assistant is not eligible for certification if the applicant has any felony convictions and has not received an absolute discharge from the sentences for all felony convictions. The absolute discharge from the sentence for all felony conviction(s) must be received 3 or more years before submitting this application. If you cannot prove that the absolute discharge date is 3 or more years, the Board will notify you that you do not meet the requirements for certification.
Proof of United States Citizenship is required by AZBN. Lists of documentation accepted can be found at https://www.azbn.gov/licenses-and-certifications/citizenship-and-alien-status
CITIZENSHIP/NATIONALITY/ALIEN STATUS DOCUMENTATION Federal law, 8 U.S.C. § 1641, and State law, A.R.S. § 1-501, require documentation of citizenship or nationality for certification. If the documentation does not demonstrate that the applicant is a United States citizen, national, or a person described in specific categories, the applicant will not be eligible for certification in Arizona. All applicants must submit documentation regarding their citizenship/nationality/alien status with their application. See attached list A & B for specific documentation required.
Starting June 13, 2016 each graduating student will need to have proof of legal presence in the United States on file with D and S (Headmaster) in order for the student to be scheduled for the manual skills and written CNA exams. All NA training programs will need to collect the document, photo or scan the document and upload it to Headmaster upon registration or program completion. Ideally, this identification document should be the same as the ID document(s) the student uses for state testing (e.g. AZ driver license or passport). The name on the document should exactly match the name entered in the system. A comprehensive list of documents acceptable for proof of legal presence is available at: http://azbn.gov/licensure-certification/citizenship-alien-status/
Clinical Drug Testing and Safety:
Random-Drug Screening
o Students may be required by the clinical agency to submit to a random urine drug screening at any time as a condition of continued enrollment, and clinical placement, in the nursing program.
o The instructor will provide information and locations for drug testing. This testing MUST be completed within the time frame stated in class. Do not complete drug testing at another location or before it is assigned.
Failure to comply with these directions will result in the student being dismissed from the program.
o Students testing positive for illicit drugs will be immediately removed/dismissed from the program.
“For Cause” Drug Screening/Testing
Page 4 of 22
o This refers to the use/misuse of, or being under the influence of: alcoholic beverages, illegal drugs or drugs which impair judgment while on duty in any health care facility, school, institution or other work location as a representative of the CNA Program.
o When a faculty/clinical instructor perceives the odor of alcohol or observes behaviors such as, but not limited to, slurred speech, unsteady gait, or confusion, and these behaviors cause the faculty or clinical instructor to suspect the student is impaired by alcohol or drugs, the following steps are taken:
The Clinical Instructor will
removed student from patient care/assigned work area
notify the clinical agency supervising personnel.
contact the administrator at the student’s home school regarding incident.
contact student’s parent/legal guardian to pick up immediately.
The Student
will submit to a urine drug test per clinical agency protocol.
admits to alcohol or drug use, drug screening may still be required
refuses “For Cause” Drug Screening/Testing:
o The clinical agency may restrict the student from further clinical rotations.
o Clinical instructor will contact parents to request that the student be transported home (emergency adult contact). If a responsible adult cannot arrive in an expedient time frame, student will be provided security at the facility until the student adult representative arrives for transport home. The student will not be allowed to drive.
o Positive testing results for illicit drugs will be immediately removed/dismissed from the program.
o Negative testing result, the student will meet with clinical instructor within 24 hours of the test results to discuss the circumstances surrounding the impaired clinical behavior.
If the indicator was the odor of alcohol, the student will be mandated to discontinue the use of whatever may have caused the alcohol-like odor before being allowed to return to the clinical setting.
If the indicator was behavioral, consideration must be given to a possible medical condition being responsible for the symptoms. A medical referral for evaluation may be indicated.
Based on the information provided in this meeting and further medical evaluations, if warranted, the Lead Instructor will make a decision regarding return to the clinical setting.
o Clinical Orientation must be completed as directed. https://myclinicalexchange.com Your clinical instructor will provide information regarding the clinical agency’s safety requirements in class. You must read and sign acknowledgment of Agency Safety Requirements (in black ink); this must be completed by the date assigned by the instructor. Failure to comply will result in the student not being able to attend the clinical rotation.
Illness and / or Disabilities
In circumstances of student illness, injury, or other health limitations, the AZBN, the clinical agency and DVUSD health policies must be upheld. The RN faculty member will determine a student’s ability to give adequate nursing care and will determine if the student can remain and/or return to the clinical experience, regardless of a physician’s approval for return.
Special accommodations for testing will be given only with appropriate documentation of special needs. Individual faculty will not provide extra time, different environments, study guides or dictionaries during testing.
Page 5 of 22
PROGRAM COST
Estimate Cost for the INP/NA Program:
District Office covers cost for school year 2020-2021
HOSA Membership $32.50
DVUSD logo embroidered Scrubs $80* (1 DVUSD logo embroidered scrub set:top & bottom)
Online Clinical Orientation/My Clinical Exchange $35 Arizona State Board of Nursing certifying exam $118
Background Check No charge
Random Drug Screen $32*
Online resource for final written and skills exam $50*
Nursing Assistant Student to cover cost for school year 2020-2021
HOSA Membership package $20*
Includes HOSA yearly t-shirt, certificate, FLC, SLC, HOSA merch*subject to availability
Nursing Assistant classroom/skill lab scrub uniform $50 - $100**
BLS Healthcare Provider CPR Card $50**
Physical Exam, Immunizations, TB skin test, flu shot insurance co-pay
LNA State Exam Level One Fingerprint Clearance Card Fee $100**(required for LNA student) DVUSD INP/NA program does not charge classroom, lab or clinical rotation fees
*Fees are subject to change due to outside vendors. **All costs quoted are subject to change.
DVUSD does not want financial hardships to affect the ability to participate in the DVUSD INP/NA program. Scholarships are available through DVEF and the Legacy Foundation. Please see guidance counselor for additional information.
Page 6 of 22
Arizona Board of Nursing Competencies:
1.0 Competency: Functions as a member of the health team within the health care facility &/or community.
2.0 Competency: Demonstrates ethical and legal behavior that maintains resident’s rights.
3.0 Competency: Assists in identifying the mental health and social service needs of residents.
4.0 Competency: Demonstrates effective communication.
5.0 Competency: Maintains a safe environment for the resident and others 6.0 Competency: Demonstrates general principles of infection control.
7.0 Competency: Provides basic emergency care.
8.0 Competency: Applies the principles of basic nutrition to resident care.
9.0 Competency: Provides the resident with personal care and grooming.
10.0 Competency: Measures vital signs.
11.0 Demonstrates safe transfers, positioning and turning of residents using effective body mechanics.
12.0 Competency: Cares for cognitively impaired residents.
13.0 Competency: Identifies the function, structure, common health problems & normal aging changes of each of the following systems.
14.0 Competency: Provides for comfort and rest.
15.0 Competency: Assists with diagnostic tests.
16.0 Competency: Provides care for the peri-operative resident and/or resident with special needs.
17.0 Competency: Assists in Admission/Transfer/Discharge of the resident.
18.0 Competency: Provides care for residents and family when death is imminent Course Competencies:
1. Describe the role of the nurse assistant in caring for elder clients & those with alterations in health care.
2. Describe the roles and responsibilities of the nurse assistant related to ethical & legal standards of the profession.
3. Use simple problem-solving skills when giving care to elderly clients & clients with alterations in health.
4. Describe professional communication skills specific to the nurse assistant as a member of the health care team.
5. Describe select nurse-assisting interventions designed to meet the holistic needs of clients.
6. Describe basic nurse assisting skills to ensure a safe environment and personal safety for the client.
7. Describe specific caring behaviors that are important when caring for clients and communication with members of the health care team.
8. Describe the signs and symptoms of specific diseases, conditions and alterations in client behavior.
9. Apply the principles of nutrition and fluid balance to client care.
10. Describe the special care needs of elder clients in the acute and long-term care settings.
11. Describe the basic skills and procedures needed for clients in emergencies.
12. Perform basic therapeutic, maintenance and preventative interventions identified in the client’s plan of care appropriate to the nurse assistant role.
13. Function as a member of the health care team within the health care facility.
14. Demonstrate behaviors that are in accordance with accepted standards of practice and ethical guidelines within the role of the nurse assistant.
15. Demonstrate simple problem solving to provide care to clients with alterations in health under the direction of the nursing staff.
16. Demonstrate appropriate communication skills with clients with alterations in health.
17. Demonstrate caring behaviors when interacting with clients in acute and long term agencies.
18. Demonstrate skills necessary to ensure a safe environment and protection of the client.
19. Implement nursing assistant skills that relate to basic and holistic client needs.
20. Communicate client response to appropriate nursing personnel through recording and reporting.
21. Apply common medical terms used for the simple organization of the body, major organs & medical abbreviations.
Page 7 of 22
GRADING:
OBJECTIVE:
Proctored quizzes, tests, and final exam (total points must meet or exceed 75% to meet AZBN requirements). Once the student has achieved 75% on quizzes, tests, and final exam, the rest of the grades are added.
Homework must be turned in on time or early. If absent on due date submission is made day student returns to class. If late, 25% will be deducted from the score.
Additional assignments if applicable.
Adhering to ALL class rules.
SUBJECTIVE:
The instructor’s impressions and evaluation of student’s understanding of the material presented are measured by your ability to discuss, apply, and/or problem solve patient care topics in class.
Positive class participation (this is a column in the Canvas/PowerSchools gradebook), asking & answering questions, following directions, working well with classmates, & utilizing ALL learning opportunities.
Practicing professional behaviors (verbal and non-verbal) at all times (including breaks) and in all settings.
Taking the initiative.
Demonstrating skills / tasks according to criteria listed in text, lecture and skills list.
Adhering to ALL class rules.
Choosing NOT to take an active role in EACH class could reflect significantly on the grade.
Grades are weighted and calculated on a percentage of points possible as follows:
Grade Breakdown Percent
Exams & Quizzes (Unannounced and announced) 15%
Comprehensive Final Exam (75% or higher must be achieved, to pass the nursing assistant program; see AZBN) 10%
After 75% has been achieved on the exams & quizzes, the following will be calculated into the grade
Homework assignments: Late Homework is accepted and will have grade decreased by 25%. 5%
Positive Classroom Participation -- Attendance/Late/Tardy 10%
Skill Lab – Skills must be evaluated and signed off on skills checklist prior to practicing skills in clinical setting. 30%
Clinical Evaluation -- if clinical is failed, the student ineligible to take state certification exam 30%
The following interpretations are used for the letter grades:
90-100%= A 80-89% = B
70-79% = C Student with an average score below 75% are unable to take the AZBN certification examination.
60-69% = D (Not passing) Below 60% = F (Not passing) Scores are NOT rounded.
TOTAL 100%
Extra Credit does NOT exist for DVUSD INP/NA
Page 8 of 22
Clinical Evaluations:
The INP/NA instructors are qualified registered nurses, as required by the AZBN. Students are not allowed at clinical site without clinical instructor. Our clinical instructor will supervise students while at the clinical sites with a 1:10 teacher to student ratio. Clinical Evaluations are used to assess or appraise the student’s performance in the clinical setting.
Evaluations are based on the student’s ability to meet or exceed the clinical objectives as described on the Clinical Evaluation tool. The Evaluations require a student to perform all objectives at a level of P = proficiency or M = Mastery by the end of the clinical experience in order to pass the clinical portion.
DVUSD INP/NA Clinical & Skill Lab SUBJECTIVE:
The instructor’s impressions and evaluation of student’s understanding of the material presented are measured by your ability to discuss, apply, and/or problem solve patient care topics in class.
Positive class participation (this is a column in the Canvas/PowerSchools gradebook), asking & answering questions, following directions, working well with classmates, & utilizing ALL learning opportunities.
Practicing professional behaviors (verbal and non-verbal) at all times (including breaks) and in all settings.
Taking the initiative.
Demonstrating skills / tasks according to criteria listed in text, lecture and skills list.
Adhering to ALL class rules.
Choosing NOT to take an active role in EACH class could reflect significantly on the grade.
READING ASSIGNMENTS AND HOMEWORK will be done BEFORE the class session (in which the material is presented) or date indicated in “Class Schedule” or by instructor. Homework will be collected at the beginning of each class session. If homework is turned in after the beginning of class, it will be considered late and the score will be decreased by 25%.
Correct spelling, grammar is expected in all written work or points will be deducted. Students are expected to be prepared to discuss, ask, or answer questions regarding topics in the reading assignment each class day. Coming to class unprepared can negatively reflect on the student’s grade and could result in possible termination from program. Graded homework is considered a study guide. Semester exams are cumulative. Students are encouraged to keep all handouts and workbook assignments
Test Day Rules:
A #2 pencil is needed for all of the exams. All exams and quizzes are timed.
All belongings (books, notebooks, backpacks, purses or other luggage used to transport class material) must be placed at the front or side of the classroom.
All cell phones, must be turned off and secured in assigned slot at back of the room.
No hats, ball caps or visors can be worn during the exam.
Please use the bathroom prior to taking the exam – no bathroom breaks will be allowed.
The instructor CAN NOT answer any questions about the exam once the exam begins
Upon completion of your exam, you must sit silently and do not cause disruptions before being released.
Exam Review:
Students will review quiz and exam during the same class period. Questions and clarification will be addressed at that time. If you receive a score of less than 75% on a quiz or exam, the student is eligible to retake that quiz or exam 1 time.
Arrangements for the re-quiz or exam will be made accordingly. Recording and/or note taking during an exam review is not allowed.
Page 9 of 22
Grade Grievances
Student concerned about a grade should discuss their concern with the teacher. If not resolved, the "chain of command"
protocol should be followed:
● Student will discuss issue further with CNA Program Coordinator
● If issue remains unresolved, student may make written request to meet with Department Chairperson and Assistant Principal of Curriculum/Designee for further resolution.
Dress Code:
Students will observe the standard school’s dress code for lecture on days that scrubs are not required. All other days proper nursing assistant scrub uniform must be adorn. NO perfumes, colognes, after shave, etc., are allowed due to allergy issues in class and at clinical site.
The Nursing Assistant uniform is required for all clinical experiences. The uniform consists of:
1. Top
a. Classroom and skill lab: Pull over scrub top V-neck or unisex scrub top. You may wear plain black or white under shirt or camisole tucked into scrub pants. A longer sleeve plain black/white under shirt (with sleeves no longer than 3/4 sleeved – that ends half way between elbow and wrist) may also be worn. Cuffs will be in good repair, clean and well fitted to the forearm.
b. Clinical: Pull over DVUSD logo embroidered scrub top V-neck or unisex scrub top. You may wear plain black or white under shirt or camisole tucked into scrub pants. A longer sleeve plain black/white under shirt (with sleeves no longer than 3/4 sleeved – that ends half way between elbow and wrist) may also be worn. Cuffs will be in good repair, clean and well fitted to the forearm.
2. Pants
a. Classroom and skill lab: Scrub pants that will be hemmed neatly and will not touch or drag on the floor.
Uniform pants will be worn at the natural waistline and not below.
b. Clinical: Scrub pants will be solid color matching DVUSD logo embroidered scrub top that will be hemmed neatly and will not touch or drag on the floor. Uniform pants will be worn at the natural waistline and not below.
3. ALL BLACK OR WHITE, CLOSED TOE, LEATHER-LIKE ATHLETIC TYPE SHOES OR UNIFORM STYLE SHOES with low heals.
Shoes need to be comfortable. If you are unsure if the shoe will meet requirements, clear them with the instructor prior to the first skill lab. Clog or sling back style shoes are not acceptable. Solid plain black socks or nylons will be worn. Shoes & laces must be clean and in good condition at all times.
4. Your uniform will be CLEAN & PRESSED (WRINKLE FREE) at the beginning of each lecture, skill lab and clinical date. A minimum of one complete DVUSD logo embroidered uniform set is required.
5. Appropriate undergarments will be worn and will not be visible while they are in any position (standing, squatting, or bending over). Thong style underwear will NOT be worn while in uniform.
6. Hair will be neat. Any hair that can touch the collar or must be pulled back. Longer hair will be put up and contained (no ponytails) for safety factors. No “Messy Buns” or bangs allowed if they are long enough to fall into the student’s
Page 10 of 22
visual field. A plain narrow (no wider than one inch) solid colored red, black, or white headband (no bows, sparkles or any other adornment) can be worn. Students with pre-existing facial hair (on the first day of class), will keep it neatly trimmed and the surrounding areas of the facial hair will be neatly shaved. No new facial hair allowed once class starts.
7. Only one set of small plain (studs with gems, sparkles, etc.) earrings maybe worn. No other visible piercing (including tongue) are allowed. Tattoos that are offensive or in bad taste must be covered. No necklaces (exceptions are for religious reasons and must be cleared by the instructor) are allowed, for safety reasons. No rings will be worn. Nail polish, if worn, will be clear or light pink in color, no sparkles, adornments or designs on nails. Nails will be kept clean and short. Artificial nails of any type are not acceptable. Medical Alert bracelets are allowed.
8. DVHS Student Picture ID badge and facility badge (if required) will be worn on the upper left side of the uniform at all times. Badge clip will be provided. No other device will be used.
9. No cell phones allowed. If student is found using cell phones for communication of any type or taking pictures in the clinical setting could face disciplinary action.
10. No Gum chewing while in uniform Course Materials
Program to supply the following:
Class textbook – Nursing Assistant student has a class textbook assigned to them for the school year. Textbook must be returned in good condition (ie not written in, no ripped paged) or the student’s account will be charged for the full purchase price of the book.
Class workbook – Nursing Assistant student is given one for personal use and allowed to keep.
Any worksheets, reference materials and student learning packets used for this class.
Arizona NA Candidate Handbook
Skills Checklist
Student to supply the following:
Classroom/Skill lab:
One 3-ring, 2–inch notebook
One 5 set, 3 hole punched, tab dividers w/ pockets College-ruled notebook paper
Pencils
Pens (black ink only)
Hair ties (hair must be pulled back) NA uniform (as described above) Your fully charged DVUSD assign iPad
Clinical:
Pen (black ink only)
Small notebook (fits in uniform pocket) Hair tie (hair must be pulled back) DVUSD logo embroidered scrub set White or black Closed-toe shoes ID badge
Watch w/ second hand (no Apple watches)
Students improperly dressed for clinical/skill lab may not be able to participate in the clinical/skill lab experience and you may be asked to leave clinical and will be counted as an absence.
Revised May 4, 2020 AJ Optional Supplies (only if you want to purchase, not required for program):
Stethoscope is highly recommended for out of class practice. This can be in any color.
Cotton Gait Belt with metal buckle
Blood Pressure Cuff is highly recommended for out of class practice. This can be in any color.
The solid plain white, red or black unisex uniform jacket is optional: No other jackets/sweaters are to be worn while at clinical agency.
Classroom, Skill Lab & Clinical Attendance:
Students must be accepted to the program and registered for the class in order to attend. Students unable to attend the first class meeting must contact the instructor prior to the beginning of the class and may, at the option of the instructor, be withdrawn.
Students are expected to attend all class, skill lab and assigned clinical rotations.
Only written excused absences from a DVUSD teacher/coach/sponsor will be accepted as an excused absence for this course.
Students who choose not to attend a class session may not meet the time requirement and will be unable to take the state certification exam. Only four 2-hour absences are permissible per semester (not including school-approved clinical absences). If student exceeds permitted absences, student must make up hour for hour the classroom and skill lab content missed up to a maximum of 4 hours only. All missed assignments and missed activities must be completed within 5 school days of absence.
On-Time Performance: Teaching Essential Workplace and Employability Skills is an integral part of the Career and Technical Education Department (CTE). It is essential to be in class and on time. Students arriving late to the campus are expected to follow the procedures of DVHS for tardiness (“Sweep” – Room 624). Professional behavior requires arriving on time or early to class and it is the student’s responsibility to plan for morning traffic as well as high school parking lot congestion. Any tardy later than 20 minutes will result in an absence for that period. The student is responsible for obtaining any work missed due to a tardy.
Students must be on time and attend ALL scheduled clinical dates. Tardiness is unacceptable and student may be sent home and may lose ability to complete clinical requirements. Leaving clinical early is not permissible.
Each semester provides the student with a different type of required patient care experience. A minimum of 40 hours (20 per semester) of clinical practicum is required for satisfactory completion for Certified Nurse Assistants. Students unable to meet the required clinical hours in a semester will not be allowed to take the Certification Exam but may receive semester credit. Students who have not completed the first semester clinical requirement cannot continue in the program for the second semester.
If student has an unexpected emergency or illness and must miss a clinical day, student MUST contact the clinical instructor at least 30 minutes prior to the start of clinical. A signed “RETURN TO WORK/SCHOOL” note from a healthcare professional is required for ANY absence.
Student absence must be reported by student’s parent/legal guardian to the student’s home school and the DVHS attendance lines. If not, an unexcused absence will be put in at DVHS. Parent/guardians have until noon on the day following an absence to excuse their child. The following information must be provided when contacting the DVHS attendance line: Student Name, Home campus, Nursing block the student attends, Instructor Name.
The DVHS attendance line numbers are: (602) 467-6707; (602) 467-6790 (voice mail); To call a student out early or check them in late:(602) 467-6899
If a student is required to leave class early due to an extracurricular school sponsored activity such as sports or fine arts on their home campus, the sponsor or parent must email the classroom instructor stating the time that the student needs to leave. Students may not leave early for after school club meetings, work, school assemblies, etc.
The nursing program consists of students from all five DVUSD high schools. It is not possible to accommodate the varied assembly schedules of each campus. If the student is required to leave campus early for a personal or medical reason, the parent must email the instructor prior to the time the student needs to leave campus that day.
Any makeup clinical hours will be available only at the discretion of the clinical instructor. AZBN defines the requirements for the CNA certification.
The instructors monitor attendance (for absences and tardiness) and will be posted in PowerSchools
Revised May 4, 2020 AJ
Instructors have the right to deny entrance to the class if students arrive after the start of class and initiate disciplinary actions for students leaving class early.
Failure to follow these requirement may result in being dropped from the program.
***** Discretion MAY BE applied in special extenuating circumstances to any individual once a final decision has been made following the discussion between an Instructor & Program Coordinator*****
Students bear the responsibility of notifying their student councilor if they decide to withdrawal at any time from the DVUSD INP/NA program.
Students will use the “Arizona Nursing Assistant Candidate Handbook” (provided) & Skills check sheet (provided) for all skill lab practice sessions. This booklet is a direct reflection of AZBN requirements for each skill, and a general idea of how the skill will need to be done for AZBN certification test. The SKILLS CHECK SHEET is used for documentation of lab practice and clinical experience. It is the responsibility of the student to maintain this sheet; it MUST be turned in at the end of the program.
Academic Responsibility:
It is the responsibility of every student to be to maintain integrity, be truthful and avoid dishonesty, fraud, or deceit of any type in connection with the nursing assistant program. Any student who violates this rule or who knowingly assists another to violate this rule shall be subject to disciplinary action and possible withdrawal from the program. This includes homework assignments. Any student who incorrectly grades homework will receive a zero (0) for that homework chapter.
As students’ progress through the curriculum, they are preparing for transition into professional life. Behaviors expected in classroom and clinical setting parallel behaviors expected in the work place.
The Nursing Faculty commits to provide an environment conducive to teaching and learning. Students can contribute to the effectiveness of the learning process and increase their chance of success by following suggestions listed below:
Expected Classroom and Clinical Behaviors:
Attend ALL class sessions and be punctual to each class meeting (Lecture, skill lab, & clinical)
Read, understand, and follow the program syllabus
Turn off and store cell phone in designated slot at back of classroom. Messages can be answered during class breaks and not during class
Cell phones are not allowed at all in the clinical or lab setting. Phones are to be left in the car when at Clinical.
Complete reading & homework assignments prior to class
Submit assignments on time
Actively and appropriately participate in class
Evaluate your own progress continuously
Meet with your instructor during office hours (appointments must be scheduled) as needed
Make appropriate verbal contributions to class
Maintain appropriate standards of professional conduct during class, skill lab and clinical for example:
o Remain in classroom until class is dismissed o Refrain from having side conversations
o Give speaker your full attention during class time o Allow others to hear and learn
o Be responsible, dependable and honest
o Laptops and iPads allowed for classroom work only (no surfing the internet or social media ie Facebook)
Revised May 4, 2020 AJ o Do not text during class
o Maintain client confidentiality (HIPPA),
Students will be notified by the instructor of any changes in course requirements or policies
DISCIPLINARY ACTION GUIDELINES
When a nursing student is in violation of any requirement contained in this Nursing Student Handbook, he/she is subject to disciplinary action or immediate dismissal. All students should carefully review the contents of this handbook.
Program Exit/Dismissal Protocol *
The following are the steps that will be followed to exit or dismiss a student from the INP/NA program:
First violation: A conference will be set up including the student, classroom instructor, and clinical instructor. The student is given a written warning that requires a parent signature. The signed written warning must be returned to the instructor(s) the following class day.
Second violation: A conference will be set up including the student, classroom instructor, and clinical instructor. The parent(s)/guardian will be contacted regarding the situation. The student is then put on probation.
Third violation: The student will be exited from the program. Parents and the student’s counselor will be notified so that other arrangements for the student’s schedule can be made.
* Automatic dismissal will result from the following:
⮚ Possession of cell phone in a clinical facility
⮚ Use of a Hoyer lift if under the age of 18
⮚ Any behavior, performance or actions that affect patient safety
⮚ Forgery, theft or grievous unprofessional behavior
STUDENT RECORD MAINTENANCE
The following records will be kept on file in a locked cabinet in the Intro to Nursing Department Office:
Student skill check lists.
Student evaluations of instructors/program
Copies of AZBN reports
Copies of student certificates of completion
Copies of final exam grades
Copies of student certification testing results
Social Security number
The following student records will be kept on file in the Deer Valley High School Administration Office due to school district rules and regulations regarding student rights to confidentiality:
Student attendance
Student discipline referrals
Student grievances
Student date of birth
All records will be kept on file for a three-year period in accordance with the Arizona State Board of Nursing policies.
METHODS OF PROGRAM EVALUATION
Each student is given the opportunity to anonymously and confidentially evaluate the program instructors, curriculum, classroom environment, clinical instructor, clinical setting, textbook and resources of the program provided at the completion of the program
Nursing Program Grievances
Any grievances against the nursing program itself can be addressed directly to the Arizona State Board of Nursing http://www.azbn.gov
Revised May 4, 2020 AJ READ the DVUSD INP/NA Handbook (also available in student Canvas ) AFTER READING sign in BLACK INK the following pages:
1. Student Information Sheet
2. Syllabus Acknowledgment Receipt 3. Integrity
4. Release of Information
5. Information for Nursing Assistant Students
6. Voluntary Assumption of Risk and Release of Liability 7. Student Confidentiality Agreement
8. Supplement Video Resources
The pages will be collected on the first Friday of class ..
Your health records will be uploaded into “My Clinical Exchange”
Your clinical requirements will also uploaded into “My Clinical Exchange”
WELCOME - WE HOPE YOU ENJOY THE CLASS!
Revised May 4, 2020 AJ STUDENT INFORMATION SHEET
(Personal contact information is used only for identification and if I need to contact you).
NAME: ________________________________________________________________________
Last (legal name) First (legal name) Name you want to be called
PRIMARY EMAIL ADDRESS: __________________________________________________________
PHONE(S): (_________) ________________ (___________) __________________
PRIMARY CONTACT NUMBER SECONDARY NUMBER
Why are you taking this program? ______________________________________________________
What are your long terms goals? ______________________________________________________
What is your primary language? ______________________________________________________
Home School: ______________________________________________________
Emergency Contacts – It is your responsibility to keep this record up-to-date. If changes offer please update instructor with required and approved emergency contacts.
#1 Parent full name: ______________________________________________________
Place of work: ______________________________________________________
1st try phone # ______________________________________________________
2nd try phone # ______________________________________________________
Email where parent/guardian can be reached: ____________________________________________
If parent cannot be reached …full name: ______________________________________________________
Relationship to student: ______________________________________________________
Phone #: ______________________________________________________
Email where parent/guardian can be reached: ____________________________________________
This form will be turned in on the first Friday of class
Revised May 4, 2020 AJ INTRODUCTION TO NURSING PROFESSIONS/NURSING ASSISTANT
STUDENT AND PARENT COURSE SYLLABUS SIGNATURE PAGE
I acknowledge that I have received a copy of the course syllabus for DVUSD INP/NA program. I have read it as directed by my instructor, before signing this form and understand the syllabus. I understand what is expected of me to successfully complete INP/NA program with a specific grade in this class. I am also aware it is my responsibility to understand the Deer Valley Unified School District policies included in the Deer Valley High School student handbook.
Any questions I had regarding the information contained in the syllabus have been answered to my satisfaction. Failure to adhere to the policies listed student is subject to disciplinary action or withdrawal from the program. If circumstances are such that I cannot complete the semester, I understand that it is my responsibility to withdraw officially from the course. If I do not withdraw officially, I know that I will receive a course grade and that the instructor is required by law to report when I last attended class.
My signature below affirms that I will actively work to promote a positive learning environment.
I agree to be responsible for maintaining a positive learning environment for others. I understand the basic rights and responsibilities of all students as members of the College Community, to reflect positive and respectful behavior.
Therefore, I will ascribe to the following guidelines for positive classroom environment:
1. Come to class on time and don’t leave early before dismissal 2. No side conversations, talking in class can be disruptive to others
3. Turn off cell phones. Personal computers and DVUSD issued iPads may be used to access class materials, but not for surfing or email
4. Leave classroom during breaks provided to use the bathroom or return phone calls.
5. Take care to minimize noisy distractions with backpacks, books, laptops
6. Remain attentive in class. I will not sleep, use laptop for non-classroom materials, or do other work in class 7. Be respectful of the instructor and others
8. Come prepared and participate in the class discussions and activities 9. Not dominate discussions, make rude or inappropriate remarks 10. Say PLEASE and THANK YOU
11. Not take credit for someone else’s work and will pull own weight 12. Not talk behind someone’s back or complain about someone else
13. Address problems professionally - only and directly with students involved 14. Not isolate anyone from their fellow students
15. Not have a condescending attitude toward any other student
16. I agree to use Social Networking sites appropriately and will refrain from posting confidential or offensive content, from harassing or making personal attacks, or aggressive behavior.
If I feel uncomfortable with behavior, I agree to:
1. Seek the advice of a trusted mentor or counselor 2. Do my job and do it well
3. Remember my true worth and not feel bad about myself, and not show weakness
If I fear physically or inappropriately threatened, I agree to report it immediately to the appropriate person: faculty, department chair, or police
_________________________________ _________________________________ ___/___/___
Student (Print Name) Student Signature Date
_________________________________ _________________________________ ___/___/___
Parent/Guardian (Print Name) Parent/Guardian Signature Date This form will be turned in on the first Friday of class.
Revised May 4, 2020 AJ INTRODUCTION TO NURSING PROFESSIONS
STUDENT AND PARENT INTEGRITY SIGNATURE PAGE
This Handbook prescribes standards of conduct for students enrolled in the Nursing Assistant Program. The standards are in addition to those prescribed for students under Deer Valley Unified School District policies and administrative regulations. Violation of any such standard may serve as grounds for program dismissal, suspension, or other discipline.
Every student is expected to know and comply with all current policies, rules, and regulations as printed in the student handbook.
I have received a copy of the Nursing Assistant Student Clinical Handbook. I understand this handbook contains information about the guidelines and procedures of the Nursing assistant program. I can find information specific to course in the course syllabus.
It is the responsibility of every student to have integrity –the practice of being honest and showing a consistent and uncompromising adherence to strong moral and ethical principles and values. Students are expected to use common courtesy at all time. School policies and procedures will be followed while on any school campus and school activity.
Any student whose conduct in the classroom, lab and clinical setting is disruptive, destructive, obscene, or a threat to the health or safety of others is subject to disciplinary actions or withdrawal from the program.
My signature below affirms that I will not cheat* or knowingly give or receive assistance to classmates on examinations or any written assignments which are collected, nor will I condone the cheating of others. I agree to sign a similar honor statement with each exam. I understand that sanctions for academic dishonesty may include academic probation, lowering of my course grade, additional assignments, and/or course failure.
* Cheating includes (but is not limited to) activities including using notes on a closed book exam, copying another person’s work, use of paraphrase or quotes from another writer without documentation of the source, and having another person do an assignment.
_________________________________ _________________________________ ___/___/___
Student (Print Name) Student Signature Date
_________________________________ _________________________________ ___/___/___
Parent/Guardian (Print Name) Parent/Guardian Signature Date
This form will be turned in on the first Friday of class.
Revised May 4, 2020 AJ INTRODUCTION TO NURSING PROFESSIONS
STUDENT AND PARENT RELEASE OF INFORMATION SIGNATURE PAGE
I hereby give permission to faculty, staff and administrative officials of Deer Valley Unified School District, Deer valley High School INP/NA Program to release to the Arizona State Board of Nursing education records maintained in connection with my participation in the Program, including but not limited to, grades, admission records, transcripts, student formative/summative clinical evaluation tools, student handbook signature acknowledgment forms, health and safety documentation forms, application forms, and any and all records pertaining to discipline, including alleged violations of the provisions of the nursing assistant program student handbook, student discipline code violations, academic misconduct, and all other forms of discipline. The purpose of such disclosure is to provide the records to the Arizona State Board of Nursing in support of that agency’s certification, licensure, and disciplinary activities.
I give permission for the nursing faculty and/or the nursing assistant program administration to share my personal information; including name, date of birth, and documentation of the health and safety requirements to clinical agencies requesting this information.
I understand that my personal identifying information may be shared with health care agencies needing this information to enter me in their security system, in their computer system, and/or in their medication administration system.
_________________________________ _________________________________ ___/___/___
Student (Print Name) Student Signature Date
_________________________________ _________________________________ ___/___/___
Parent/Guardian (Print Name) Parent/Guardian Signature Date
This form will be turned in on the first Friday of class.
Revised May 4, 2020 AJ INFORMATION FOR NURSING ASSISTANT STUDENTS This form will be turned in on the first Friday of class.
ZERO TOLERANCE POLICY: The Nursing Assistant Program supports a Zero Tolerance Policy for the following behaviors:
o Intentionally or recklessly causing physical harm to any person on the campus or at a clinical site, or intentionally or recklessly causing reasonable apprehension of such harm.
o Unauthorized use or possession of any weapon or explosive device on the campus or at a clinical site.
o Unauthorized use, distribution, or possession for purposes of distribution of alcohol or any controlled substance or illegal drug on the campus or at a clinical site.
Nursing Assistant students engaging in this misconduct are subject to immediate dismissal from nursing classes and disciplinary action as described in the Student Handbook.
HEALTH DECLARATION: It is essential that nursing assistant students be able to perform a number of physical activities in the clinical portion of the program. At a minimum, students will be required to lift clients, stand for several hours at a time and perform bending activities. Students who have a chronic illness or condition must be maintained on current treatment and be able to implement direct client care. The clinical nursing experience also places students under considerable mental and emotional stress as they undertake responsibilities and duties impacting clients’ lives. Students must be able to demonstrate rational and appropriate behavior under stressful conditions. Individuals should give careful consideration to the mental and physical demands of the program prior to making application. All must provide documentation of compliance with all health and safety requirements required to protect client safety. Only students in compliance are permitted to enroll in nursing courses. Students will meet these requirements by providing the Health/Safety Requirements Documentation Checklist and the signed Health Declaration Form.
DRUG SCREENING: All students are required to complete the urine drug screening procedure under the program account number, within the specified timeframe, and according to directions given at the time of notification. Only students in compliance with the screening guidelines and receiving a negative drug screen, as reported by the Medical Review Officer (MRO), will be permitted to continue their enrollment in nursing courses.
BACKGROUND CLEARANCES: All students must undergo a background check to verify identity, social security number, and to show proof that they do not appear on the List of Excluded Individuals/Entities (LEIE) database. Any student who becomes sanctioned or excluded while enrolled in the program will not be permitted to continue in the nursing assistant program.
NURSING ASSISTANT CERTIFICATION GUARANTEE: Admission or completion of the Nursing Assistant program does not guarantee obtaining certification as a nurse assistant. Certification and subsequent procedures are the exclusive right and responsibility of the Arizona State Board of Nursing. Students must satisfy the requirements of the Nurse Practice Act: Statutes, Rules and Regulations, independently of any college or school requirements for graduation.
Pursuant to A.R.S. § 32-1606(B)(17), an applicant for certification by examination is not eligible for certification or licensure if the applicant has any felony convictions and has not received an absolute discharge from the sentences for all felony
convictions. The absolute discharge must be received five or more years before submitting this application. If you cannot prove that the absolute discharge date is five or more years, the Board cannot consider your application. All nursing assistant
applicants for licensure will be fingerprinted to permit the Department of Public Safety to obtain state and federal criminal history information. The Fingerprint Clearance Card required for the nursing assistant program will not meet the requirements for certification or licensure through the Arizona State Board of Nursing. Effective January 1, 2008 applicants for licensure in Arizona must provide evidence of citizenship or nationality. If there are any questions about eligibility for licensure or certification, contact the Arizona State Board of Nursing http://www.azbn.gov or 602.889.5150.
I have read and I understand the information presented on this form.
_________________________________ _________________________________ ___/___/___
Student (Print Name) Student Signature Date
_________________________________ _________________________________ ___/___/___
Parent/Guardian (Print Name) Parent/Guardian Signature Date
Revised May 4, 2020 AJ VOLUNTARY ASSUMPTION OF RISK AND RELEASE OF LIABILITY
THIS IS A RELEASE OF LEGAL RIGHTS. READ AND UNDERSTAND IT BEFORE SIGNING.
Deer Valley Unified School District are non-profit educational institutions. References to Deer Valley Unified School District include its officers, officials, employees, volunteers, students, agents, and assigns.
I (print your name) (IN BLACK INK), freely choose to participate in
the Nursing assistant program. In consideration of my voluntary participation in this Program, I agree as follows:
RISKS INVOLVED IN PROGRAM: I understand that the clinical training environment for this Program in which I am enrolled through Deer Valley Unified School District contains exposures to risks inherent in activities of the Program such as but not limited to bodily injury, communicable and infectious diseases, and property damage.
HEALTH AND SAFETY: I have been advised to consult with a medical doctor regarding my personal medical needs. I state that there are no health-related reasons or problems that preclude or restrict my participation in this Program. I have obtained the required immunizations. I recognize that Deer Valley Unified School District are not obligated to attend to any of my medical or medication needs, and I assume all risk and responsibility therefore. In case of a medical emergency occurring during my participation in this Nursing Assistant Program, I authorize in advance the
representative of Deer Valley Unified School District to secure whatever treatment is necessary, including the administration of anesthetic and surgery. Deer Valley Unified School District may (but is not obligated to) take any actions it considers to be warranted under the circumstances regarding my health and safety. I agree to pay all expenses relating thereto and release Deer Valley Unified School District from any liability for any actions.
ASSUMPTION OF RISK AND RELEASE OF LIABILITY: Knowing the risks described above, and in voluntary consideration of being permitted to participate in the Program, I hereby knowingly assume all risks inherent in this activity and connected activities. I agree to release, indemnify, and defend Deer Valley Unified School District and their officials, officers, employees, agents, and volunteers from and against any and all claims, of whatsoever kind or nature, which I, the participant, my parents or legal guardian or any other person may have for any losses, damages or injuries arising out of or in connection with my participation in this Program.
SIGNATURE: I indicate that by my signature below that I have read the terms and conditions of participation in this Program and agree to abide by them. I have carefully read this Voluntary Assumption of Risk and Release of Liability and acknowledge that I understand it. No representation, statements, or inducements, oral or written, apart from the foregoing written statement, have been made. This Voluntary Assumption of Risk and Release of Liability shall be governed by the laws of the State of Arizona that shall be the forum for any lawsuits filed under or incident to this Form or to the Program. If any portion of this Form is held invalid, the rest of the document shall continue in full force and effect.
_________________________________ _________________________________ ___/___/___
Student (Print Name) Student Signature Date
_________________________________ _________________________________ ___/___/___
Parent/Guardian (Print Name) Parent/Guardian Signature Date This form will be turned in on the first Friday of class .
Revised May 4, 2020 AJ STUDENT CONFIDENTIALITY AGREEMENT
Name (Print): ___________________________ (IN BLACK INK) Status: Nursing Assistant Program Student
The discussions, uses, and disclosures addressed by this agreement mean any written, verbal, or electronic communications.
I understand that I am never to discuss or review any information regarding a client at a clinical site unless the discussion or review is part of my assignment to the site. I understand that I am obligated to know and adhere to the privacy policies and procedures of the clinical site to which I am assigned. I acknowledge that medical records, accounting information, client information, and conversations between or among healthcare professionals about clients are confidential under law and this agreement.
I understand that, while in the clinical setting, I may not disclose any information about a client during the clinical portion of my clinical assignment to anyone other than the medical staff of the clinical site.
I understand that I may not remove any record from the clinical site without the written authorization of the site.
Additionally, I understand that, before I use or disclose client information in a learning experience, classroom, case presentation, class assignment, or research, I must attempt to exclude as much of the following information as possible:
Names
Geographical subdivisions smaller than a state
Dates of birth, admission, discharge, and death
Telephone numbers
Fax numbers
E-mail addresses
Social security numbers
Medical record numbers
Health plan beneficiary numbers
Account numbers
Certificate/license numbers
Vehicle identifiers
Device identifiers
Web locators (URLs)
Internet protocol addresses
Biometric identifiers
Full face photographs
Any other unique identifying number, characteristic, or code
All ages
Additionally, I acknowledge that any client information, whether or not it excludes some or all of those identifiers, may only be used or disclosed for health care training and educational purposes at DVUSD INP/NA Program, and must otherwise remain confidential.
I understand that I must promptly report any violation of the clinical site’s privacy policies and procedures, applicable law, or this confidentiality agreement, by me, or an DVUSD INP/NA Program student or faculty member to the appropriate DVUSD INP/NA Program clinical coordinator or program director.
I understand that, if I violate the privacy policies and procedures of the clinical site, applicable law, or this agreement, I will be subject to disciplinary action that may include dismissal from the program.
By signing this agreement, I certify that I have read and understand its terms, and will comply with them.
_________________________________ _________________________________ ___/___/___
Student (Print Name) Student Signature Date
_________________________________ _________________________________ ___/___/___
Parent/Guardian (Print Name) Parent/Guardian Signature Date
Revised May 4, 2020 AJ Supplement Video Resources
In addition to district approved video clips, other videos may be shown to complement instruction on certain topics. By signing the Video Procedure and Clearance form (located at the back of the handbook), the parent/guardian acknowledges and gives consent to the use of additional video material in the classroom. Alternative assignments will be made available to students who do not have permission to view the videos.
SUPPLEMENTAL VIDEO LIST
Something the Lord Made- true story of first open heart surgeries for “blue babies”
Tuesdays with Morrie- based on book, a look at death and dying, hospice care
Five People You Meet in Heaven – Importance of relationships while still here on earth, death and dying The Forgetting - focuses on Alzheimer’ disease
Patch Adams - based on a doctor who questioned convention methods of treatment; looks at medicinal effect of humor
The Other Sister- a mentally challenged young woman faces the normal things of growing up; how the mentally challenged can be independent
My Sister’s Keeper – focuses on cancer, death and family relationships The Temple Grandin Story – based on a true story, discusses Autism The Notebook – focuses on Alzheimer’s disease
Return to Me – focuses on heart transplant and family relationships I Am Sam – focuses on mental health issues and support
A Walk to Remember – focuses on leukemia, dying and family relationships The Ultimate Gift – focuses on cancer, dying and making good choices Soul Surfer – focuses on amputation, coping and following dreams
Mr. Holland’s Opus – focuses on teaching, music, deafness and family relationships Wild Hearts Can’t Be Broken – focuses on blindness and overcoming obstacles Charlie St. Cloud – focuses on death and dying, stages of grief
World Trade Center – focuses on first responders in a major disaster Forever Young – deals with aging
The Fault in Our Stars – focuses on cancer, dying
The Doctor – focuses on a doctor who becomes ill and changes his way of dealing with patients Regarding Henry – deals with traumatic brain injury
Gifted Hands – focuses on Dr. Ben Carson’s (brain surgeon) life
VIDEO PROCEDURES AND CLEARANCE FORM
Videos, films and other taped materials rated PG/PG-13 may be viewed at school, but they must be:
An integral part of class curriculum, Approved by administrator, Approved by parent/guardian Each student must have a signed permission form on file
________________________________ (print student’s name) has my (______________________) permission to view videos, films and other taped materials selections listed in the program.
Please list any video you do not wish your student to view:
1.)______________________________________________________________________________________
2.)______________________________________________________________________________________
3.)______________________________________________________________________________________
___________________________________________ ___________________________________________ ____/____/____
Parent/Guardian Print Parent/Guardian Signature Date